Provider Demographics
NPI:1982907242
Name:BRIDGE CREEK DENTAL PC
Entity Type:Organization
Organization Name:BRIDGE CREEK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WASSMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-652-1600
Mailing Address - Street 1:525 HENRY CHAPPLE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1865
Mailing Address - Country:US
Mailing Address - Phone:406-652-1600
Mailing Address - Fax:406-652-1205
Practice Address - Street 1:525 HENRY CHAPPLE ST STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1865
Practice Address - Country:US
Practice Address - Phone:406-652-1600
Practice Address - Fax:406-652-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment